Pratikaki M, Platsouka E, Sotiropoulou C, Vassilakopoulos T, Paniara O, Roussos C, Routsi C
Department of Intensive Care, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece.
Epidemiol Infect. 2009 May;137(5):727-35. doi: 10.1017/S0950268808001271. Epub 2008 Sep 16.
To determine the incidence, risk factors for, and the influence of bloodstream infections (BSIs) on mortality of patients in intensive-care units (ICUs), prospectively collected data from all patients with a stay in an ICU >48 h, during a 1-year period, were analysed. Of 572 patients, 148 developed a total of 232 BSI episodes (incidence 16.3 episodes/1000 patient-days). Gram-negative organisms with high level of resistance to antibiotics were the most frequently isolated pathogens (157 strains, 67.8%). The severity of illness on admission, as estimated by APACHE II score (OR 1.07, 95% CI 1.04-1.1, P<0.001), the presence of acute respiratory distress syndrome (OR 3.57, 95% CI 1.92-6.64, P<0.001), and a history of diabetes mellitus (OR 2.37, 95% CI 1.36-4.11, P=0.002) were risk factors for the occurrence of BSI whereas the development of an ICU-acquired BSI was an independent risk factor for death (OR 1.76, 95% CI 1.11-2.78, P=0.015). Finally, the severity of organ dysfunction on the day of the first BSI episode, as estimated by SOFA score, and the level of serum albumin, independently affected the outcome (OR 1.44, 95% CI 1.22-1.7, P<0.001 and OR 0.47, 95% CI 0.23-0.97, P=0.04 respectively).
为了确定重症监护病房（ICU）患者血流感染（BSI）的发生率、危险因素及其对死亡率的影响，我们对前瞻性收集的所有在ICU住院超过48小时的患者在1年期间的数据进行了分析。在572例患者中，148例共发生了232次BSI发作（发生率为16.3次/1000患者日）。对抗生素具有高度耐药性的革兰氏阴性菌是最常分离出的病原体（157株，占67.8%）。入院时的疾病严重程度（根据急性生理与慢性健康状况评分系统II [APACHE II]评分，比值比[OR]为1.07，95%可信区间[CI]为1.04 - 1.1，P<0.001）、急性呼吸窘迫综合征的存在（OR为3.57，95% CI为1.92 - 6.64，P<0.001）以及糖尿病史（OR为2.37，95% CI为1.36 - 4.11，P = 0.002）是发生BSI的危险因素，而发生ICU获得性BSI是死亡的独立危险因素（OR为1.76，95% CI为1.11 - 2.78，P = 0.015）。最后，根据序贯器官衰竭评估（SOFA）评分估计的首次BSI发作当天的器官功能障碍严重程度以及血清白蛋白水平，独立影响预后（分别为OR 1.44，95% CI 1.22 - 1.7，P<0.001和OR 0.47，95% CI 0.23 - 0.97，P = 0.04）。
